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I Have Arthritis And My Rheumatologist Is Doing An Arthroscopy ... Tell Me More...

Dec 21, 2007
Arthroscopy is a procedure that physicians or surgeons use to evaluate and treat problems inside a joint.

The word "arthroscopy" comes from two Greek words, "arthron" (joint) and "skopein" (to look).

To perform an arthroscopy, the rheumatologist makes a small incision in the patient's skin using local anesthetic and then inserts instruments that are slightly larger than the tip of a pen. The arthroscope, which is actually a small telescope, has a small lens and lighting system to magnify and light up the structures inside the joint. Light is transmitted from a light source via a fiberoptic cable to the end of the arthroscope.

A miniature television camera is also connected to the arthroscope so the rheumatologist can view the interior of the joint through a much smaller incision than that required for an open surgical procedure and even smaller than incisions made by orthopedists when they do arthroscopy.

The television camera attached to the arthroscope shows the inside of the joint on a television screen. This lets the rheumatologist examine the entire interior of the joint. A determination as to the type of problem, the best approach to fix the problem, and the need for more aggressive medical treatment can be made by this careful examination.

Diagnosing joint disease begins with a thorough medical history, physical examination, and imaging procedures such as x-rays, diagnostic ultrasound, magnetic resonance imaging (MRI) or computed tomography (CT).
Arthritis can damage cartilage, bone, ligaments, and tendons.

Inflammation is a common finding. Inflammation of the synovium (lining of the joint) is called synovitis. There are many different varieties of synovitis depending on the type of arthritis.

An arthroscopic procedure can be used to treat disease by:

* Removing pieces of damaged cartilage or meniscus
* Smoothing out damaged cartilage
* Removing inflamed synovium
* Removing loose bodies (pieces of cartilage or bone that have broken off inside the joint and which can cause pain and locking in the joint.

An arthroscopy is also extremely valuable for research purposes since it allows the rheumatologist to biopsy joint tissue (synovium and cartilage) to evaluate the effects of medications on joint disease.

Joints that the rheumatologist may choose to arthroscope include the knee, wrist, finger, ankle, and toe, among others.

Rheumatologists do not, as a rule, repair severe joint injury problems such as anterior cruciate ligament tears or rotator cuff tears. Complex injuries are best left to the orthopedist.

Arthroscopic procedures done by a rheumatologist, although much easier in terms of recovery than orthopedic arthroscopic procedures or "open" surgery, still require the use of anesthetics and the special equipment in an office procedural room. You will be given a local anesthetic as well as an oral sedative.

A small incision, about a quarter inch in length will be made to insert the arthroscope. Other incisions may be made to see other parts of the joint or insert other instruments.

When indicated, other specially designed instruments including motorized shavers, are inserted into the joint.

After arthroscopy, the small incisions will be covered with a dressing. You will be moved from the procedure room.

Before being discharged, you will be given instructions about care for your incisions, what activities you should avoid, and which exercises you should do to aid your recovery. During the follow-up visit, the rheumatologist will inspect your incisions and discuss follow up.

The amount of cutting required and recovery time will depend on the complexity of your problem. Occasionally, during arthroscopy, the physician may discover that the injury or disease cannot be treated adequately with arthroscopy alone. You may then need to be sent to an orthopedic surgeon.

Although uncommon, complications may occur occasionally during or following arthroscopy. Infection, phlebitis (blood clots of a vein), excessive swelling or bleeding, damage to blood vessels or nerves, and instrument breakage are the most common complications, but occur in less than 1 percent of all arthroscopic procedures.

Also, there is a remote chance the arthroscopist may not be able to finish the procedure if the patient is having excessive pain since the use of local anesthetic has its limits. This is very uncommon but can occur.

The small puncture wounds take several days to heal. The operative dressing can usually be removed the morning after surgery and band-aids can be applied to cover the small healing incisions.

Although the puncture wounds are small, there may be significant pain, particularly the night after the procedure. It takes several days to weeks for the joint to maximally recover. A specific activity and rehabilitation program may be recommended to speed recovery.

People who have arthroscopy can have many different diagnoses and co-morbid conditions (other medical problems), so each patient's arthroscopic procedure is unique to that person. As a result, recovery time will vary.
About the Author
Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment
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